This article provides an overview of the landmark 2012 United States Supreme Court decision National Federation of Independent Business v. Sebelius. Almost 28 months after President Barack Obama signed the Affordable Care Act (ACA) into law, the Supreme Court upheld the constitutionality of health care reform. Though the underlying arguments set forth in the majority opinion venture deep into the labyrinth of constitutional law and test the traditional boundaries of federalism, the holding itself is clear and concise: the ACA’s individual mandate is constitutional; and the Medicaid expansion provisions found within the ACA survive, but the Federal Government is prohibited from penalizing '[s]tates that choose not to participate in [the Medicaid expansion] by taking away their existing Medicaid funding.' The decision promises to have a dramatic effect for decades into the future.